It’s not easy to export the American recovery movement — even to a nation that needs it.

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It used to be a common sight in Moscow: two men, swaying on a corner and holding up three fingers in the air. A bottle of vodka cost 3 rubles back then, which meant that if there were three of you, it was an easy, cheap split. The three-finger salute was the universal sign that you were looking for investment partners.

Today, with vodka costing significantly more than it used to, the three-way split is not the standby it once was. But you can still see Russia’s drinking problem everywhere—in its cities and especially in its rural, less populated provinces. A 2011 report from the World Health Organization estimated that Russians were drinking an average of about 4 gallons of pure alcohol per year—about 70 percent more than their American counterparts. In 2009, the British medical journal The Lancet estimated that more than half of all Russians dying between the ages of 15 and 54 were dying from excessive drinking. More than half the children in a typical Russian orphanage, another study found, suffer from fetal alcohol syndrome.

The country’s leaders have tried over the years to stanch the problem by making alcohol harder to buy, most recently in 2009, when then-president Dmitry Medvedev declared alcoholism a “national disaster” and ordered a raft of new regulations. But historically, nothing has really worked. Meanwhile, treatment for alcohol abuse, when given, looks very different in Russia than it does in the United States. Usually, it involves a single doctor visit during which patients go through a round of detox before being hypnotized and given a prescription for antidrinking pills.

To American eyes, something important is missing from Russia’s effort to fight alcoholism: a recovery movement built around a long, sustained support process that attacks addiction at its core and teaches people how to live a sober life. In the United States, this kind of recovery has become practically synonymous with one organization, Alcoholics Anonymous. The 80-year-old movement has achieved huge successes based on the idea that alcoholism is a lifelong disease, and that people who suffer from it can find strength by submitting to a “higher power” and sharing their struggles with strangers going through the same thing. Around the world, more than 2 million people count themselves as members of AA, and the organization’s literature has been translated into 71 languages.

Oleg Nikishin/Getty Images/File 2001

Drunk men asleep in the grass during a festival in June 2001 in the village of Baltaci, in the Tatarstan region of Russia.

But in Russia, despite the passionate efforts of its proponents, AA has struggled for acceptance as a legitimate treatment method and has largely failed to catch on. Since 1987, when an Episcopal priest from New York convened some of Russia’s very first AA meetings, only about 400 groups have formed in the entire country—a tiny number, when you consider that there are about 1,600 such groups in the Boston metropolitan area alone.

Why has Russia proven so inhospitable to AA’s ideas? Certainly, the history of distrust between our two countries hasn’t helped. But there have been other obstacles as well—some religious, some medical, some cultural. It turns out that what looks like a benign and effective social movement in one country can start to look very different when it arrives on a new shore. Together, the difficulties AA has faced in Russia point to a fundamental obstacle to transplanting ideas across borders: Some solutions, even successful ones, may not be nearly as universal as the problems they are supposed to solve.

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Americans always laugh when you tell them the word “vodka” translates literally to “water.” Like the recent news that Kremlin officials were only just getting around to formally recognizing beer as a form of alcohol, it confirms an enduring stereotype about Russian people: that they can, and do, drink in quantities that would startle people in most other nations. The roots of Russia’s special relationship with alcohol have been the subject of widespread speculation, with some chalking it up to genetic predisposition and others pointing to the supposedly essential melancholy of the Russian soul.

GERARD FOUET/AFP/Getty Images/File 1995

Russian President Boris Yeltsin finished his glass of vodka at a Kremlin reception in 1995.

There’s also a more concrete explanation. As political scientist Mark Schrad argues in a forthcoming book called “Vodka Politics: Alcohol, Autocracy, and the Secret History of the Russian State,” drinking became embedded in Russian life because the state profited from it—both in a financial sense, by way of a monopoly on the production and sale of alcohol, and a political one, in that drunk people are easier to govern. The Russian government has demonstrated its commitment to preserving the country’s drinking culture throughout its history, according to Schrad; one vivid example in his book centers around an 1859 uprising of peasants who decided to protest the state’s liquor taxes by going sober. A British journalist who witnessed the state’s crackdown on the teetotalers reported seeing peasants getting liquor “poured into their mouths through funnels” before being “hauled off to prison as rebels.”

Such extreme scenarios aside, the Russian state’s official stance toward alcohol consumption can best be described as noncommittal, with a number of the country’s leaders taking steps at various points to curb excessive drinking, but never attacking the problem at its root. Svetlana Moseeva, who operates a free alcohol recovery center outside of St. Petersburg, sat at a Starbucks in New York recently during a visit from Russia, and compared her country’s record of dealing with alcoholism to that of a drunk man who decides one morning to kick his habit and finally dry out, only to pick it back up the next day. “They think, ‘OK, we did something, we put a check mark next to the problem, and now we can calm down,’” Moseeva said.

For Moseeva, counting on the government to solve the problem through top-down bureaucratic means—by limiting the production of alcohol, for instance, as Mikhail Gorbachev did during the 1980s—is pointless. What’s needed instead, in Moseeva’s view, is to acknowledge the millions of Russians who cannot imagine living their lives without alcohol—who would drink no matter what kinds of limits or taxes the government imposed on liquor sales—and to provide them with treatment.

Moseeva belongs to a network of people in Russia who believe Alcoholics Anonymous should be playing a much bigger part than it is in delivering that treatment. Her organization, The House of Hope on the Hill, was founded 17 years ago and to this day is one of just a handful of centers in Russia that uses AA’s 12-step method. Over the years, the House of Hope has treated some 6,000 Russians, and claims a success rate of 30 to 40 percent. “I see the results with my own eyes,” Moseeva said. “Every June the center has a celebration for its anniversary, and our alumni gather from all over Russia. And when we see them...they have changed their lives, they’ve gotten their families back, they’ve stood up on their feet.”

The House of Hope’s continued existence is a success story, as is the fact that its alumni have gone on to “seed” AA groups all over Russia. But measured against the scale of the problem—in 2000, one expert estimated there were 20 million alcoholics in Russia—its successes start to look modest. Over nearly 30 years of effort, and despite the work of some very committed advocates, AA has barely gained a toehold.

VASSILY KORNEYEV/AFP/Getty Images/File 1993

Three Russian paratroopers drink vodka, celebrating National Paratroop Day in Gorky Park in August 1993.

Though accounts vary, credit for bringing AA to the Soviet Union generally goes to an Episcopalian priest from New York named J. W. Canty. After hearing, in 1985, about Gorbachev’s anti-alcohol campaign, Canty decided to dedicate himself to helping Russia solve its drinking problem. Among other things, Canty distributed AA literature to Soviet officials and doctors, put together a trip to the United States so they could sit in on actual AA meetings, and even tried to convince the Soviet Ministry of Culture to stage a ballet about alcoholism at the Bolshoi Theater. Starting in 1987, he also organized some of the first AA meetings to ever take place in Russia.

By 1994, there were 58 groups meeting around the country. The fledgling movement got another push from an American tobacco executive and AA member named Lou Bantle, who visited Russia in the late 1980s and found himself aghast at the way alcoholics were treated there. With the help of a Russian-born, New York-based therapist named Eugene Zubkov, Bantle started an organization that brought Russian alcoholics, including a number of famous rock stars, to America so they could attend 12-step programs and then spread the word back home about AA’s efficacy. Then, in 1996, Bantle and Zubkov opened The House of Hope.

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‘Everybody expected [AA] to skyrocket,” said Zubkov, who ran the House of Hope for many years. “But it didn’t.” Instead, it got stuck in neutral, he said, and has now “reached a plateau.” To this day, the number of meetings being held in cities like Moscow and St. Petersburg—not to mention the provinces—is wildly out of proportion to the number of alcoholics who live there. “Given the dramatic effect alcohol has on public health in Russia,” said John Kelly, the associate director of the MGH-Harvard Center for Addiction Medicine, “AA hasn’t taken off there anywhere near as much as it could.”

The reasons why, according to people who have devoted years to understanding alcoholism in Russia, are multiple and complex. The most important, perhaps, is that the Russian idea of “alcoholism” is very different from the American one: According to medical anthropologist Eugene Raikhel, the popular definition of a “drinking problem” in Russia is what happens at “the endpoint of chronic alcohol use,” not the drinking itself, which is considered perfectly normal. “They think alcoholism is when a person is homeless, lying in a ditch,” said Moseeva. “That’s an alcoholic. That a person can be more or less successful and still be an alcoholic doesn’t really register.” Even those who utterly destroy their lives through drinking tend to be regarded with understanding and sympathy: “A drunk man,” said Yanni Kotsonis, a Russian historian at New York University, “invites the pity and support of the community.” For Kotsonis, the idea of AA flourishing in Russia is a nonstarter until this attitude changes: “My sense is it cannot take root because of the general understanding that drinking alcohol is not wrong,” he said.

YURI KADOBNOV/AFP/Getty Images/File 2012

Members of the Alcoholics Anonymous at a meeting in Moscow on Dec. 1, 2012.

Russians do get treated for alcohol abuse—but it tends to happen when someone is trying to dry out after an acute bender, and usually just means seeing a doctor, going through detox, and submitting to so-called coding, during which the patient is hypnotized into believing he can never drink again. There are also drugs, like Antabuse, designed to induce headaches and nausea if the patient drinks; not long ago, it was much more common for Russian doctors to implant such substances under people’s skin with so-called torpedoes than to refer them to AA.

A further obstacle to AA’s growth in Russia is something more philosophical: At a basic level, its premise of sobriety through mutual support just doesn’t make sense to a lot of Russians. In the past, this has taken the form of anti-Western suspicion—“What are the Americans trying to get out of this?” is a question Moseeva used to hear regularly. But more fundamentally, the group-therapy dynamic collides with a skepticism about the possibility of ordinary people curing each other of anything. “The idea that another drunk can help you is asinine to most Russians,” said Alexandre Laudet, a social psychologist who has researched Russian alcoholism.

Then there’s the problem of opening up to strangers. The AA method works in part through trust in people you’ve never met before, and coming clean to them about one’s most shameful secrets. “It is much harder for a Russian person to talk about himself than it is for an American,” said a Russian AA member named Mikhail. “And there are a lot of reasons why, including that the generation of my parents—and my own, I’m 55—couldn’t speak the truth at all, because it was possible to get arrested for it.” Today, according to Moseeva, Russians are reluctant to admit in public they have a problem with alcohol because, while drinking is not considered shameful, doing it because you have some kind of psychological problem very much is. Boris Lobodov, a psychiatrist who conducted a pilot study of AA in 2007 in the city of Voronezh, said he hears the same thing from his patients whenever he suggests they attend a meeting. “Nobody believes in anonymity,” Lobodov said. “Nobody believes it, and people are afraid to be recognized.”

As a result, unlike in America, where AA and similar recovery programs are now part of the cultural landscape, in Russia they are still seen as alien. When Lobodov asked his test subjects in Voronezh whether they’d ever consider going to AA, he found they were immediately suspicious of it, saying they believed it was a cult where they would be tricked into working in a prison-like community.

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In 2011, the failure of AA to win the hearts and minds of Russians was the subject of a public hearing in Washington, D.C., hosted by the Helsinki Commission, a US agency established in 1976 to promote cooperation on human rights between the West and the Communist bloc. Zubkov testified, as did the former journalist Heidi Brown, who has written extensively about the House of Hope on the Hill and Russian alcoholism more broadly. Looming over the proceedings was a central question posed by AA’s efforts in Russia: to what extent is it possible for an idea that originated in one country to work in another, very different one? And, insofar as there is some mysterious “Russian soul” that has survived one transformative regime change after another, might it simply be incompatible with the precepts that make AA so popular in the United States?

Moseeva is optimistic. Even the Russian Orthodox Church, she points out, which was initially very skeptical of AA because of its reliance on the concept of a higher power, has softened its stance toward the organization. Some churches are even starting their own recovery programs inspired by the 12-step method. And Russia’s official addiction expert, who in the past, according to Heidi Brown, has advised Russians who like to drink a lot with dinner to open their windows a bit in order to get less drunk, has recently spoken positively about AA.

Meanwhile, AA’s advocates note that the new Russia is still young. Less than 25 years ago, the country was ruled by a totalitarian regime, and its post-Soviet culture is still, in many ways, a work in progress. “It hasn’t changed yet,” Moseeva said, about AA’s status in Russia. “But it’s starting to. How this is going to evolve, who knows? In our country everything is so unpredictable that anything’s possible.”

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